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April 9, 2021

Which science?

covid-stringency-index-2021.pngThe spring of 2021 is all about "last year at this time..."

Last year at this time I was frantically helping Privacy International track covid responses as every country passed laws, mandated curfews and other restrictions, and awarded police enforcement powers. It transpires that lots of others were thinking similarly about the need to track the different policies countries were pursuing to contain the pandemic. Tracking surveillance is important, if only to ensure that we can identify new intrusions inwhatever "new normal" emerges post-pandemic, but there are many other lessons to learn from comparisons across the world in this global, uncontrolled experiment in public health we call a pandemic.

One group doing this sort of study recently reported initial findings based on collected contributions from 600 data collectors in 186 countries comparing policies, vaccine rollouts, and so on. Most of it is negative, listing what *didn't* make a difference: the wealth of nations hasn't counted for much, nor did a nation's scientific and health care capacity by itself, and neither did the democratic or autocratic nature of a country's government.

The instinctive answer to this sort of question is that the countries that had recent experience of epidemics - HN1, SARS, MERS - understood the seriousness of the danger and how quickly exponential - viral! - growth can get out of hand and responded quickly and decisively. In some cases, such as New Zealand (26 deaths in total to April 8, 2021 for a rate of five per million population), Taiwan (10. 0.4), Vietnam (35, 0.4), China (4,636, 3), and Mongolia (18) that response has been effective over the last year (all figures from Worldometers. Other countries, such as the Czech Republic, Hungary, and Bulgaria, responded quickly to the initial threat, but then failed to use that experience to reimpose the measures that had worked for them when new waves of the pandemic arose. Some of the countries that were slow and/or chaotic about imposing lockdowns and other restrictions are at the front of vaccine rollouts. Mongolia, which has done fantastically well at curbing both case numbers and deaths, especially given its limited resources, by starting as early as January 2020 to implement low-tech public health measures, has abruptly seen its daily case load spike from 65 cases a day to 500 in the last month. The prime minister has announced a lockdown.

Eventually those doing this kind of work will be able to look across the entire experience of the pandemic to assess what worked and what didn't and make recommendations for more effective responses in future. That won't, however, be possible for at least another two years. In the meantime, some thoughts.

Even with this many countries to compare, the number of variables is staggering. Are you aiming to minimize deaths, contain costs, ensure your health care system doesn't collapse, or minimize spread? In one sense those are all the same: limit infection and the rest follows. But take vaccines, still patchily available, which goal you prioritize changes who gets protected first: minimizing deaths and hospital admissions means starting with the oldest, as in the US and UK, while minimizing spread might mean first targeting the most mobile, 20- and 30-somethings. If you're a scientist you develop models you hope resemble reality that let you see the results of different strategies. If you're a politician in the US or UK, you might be tempted to remember that old people vote.

One thing I think will become (even more) clear in hindsight is the tension in many countries between the magnetic attraction of new information technology approaches such as AI and risk modeling and the plodding effectiveness of low-tech public health approaches. It's very tempting to view this as the difference between "male" and "female" approaches, particularly because washing your hands, avoiding people when you're sick, and opening a window are the kinds of things your mother might have told you to do, and you're a grown-up now. It's more likely, though, that the last 50 years of high-speed computer industry developments have left us too inclined to think newer must be better.

In some cases this is true; certainly, the new mRNA vaccines seem set to achieve numerous breakthroughs against diseases that have proved recalcitrant until now, and without the Internet we would have been far more isolated and scientists could never have responded so quickly and so collaboratively. But in others our modern gizmos have been largely a distraction. Remember last year's mad rush to develop contact tracing apps? That whole controversial effort appears to have been largely pointless. The UK's app has been downloaded 21 million times...and so what? The country still has one of the highest covid death rates in the world (fifth in number of deaths, 13th in deaths per million population). As Jonny Ball and Michael Goodier write at New Statesman, contact tracing apps help provide manual contact tracers with leads to work with; they are no substitute for robust local laborious effort.

So my guess is that when the dust settles key advice will be that you can't automate your way out of a pandemic. Last year around this time, US Speaker of the House Nancy Pelosi said, "...And for those who choose prayer over science, I say that science is the answer to our prayers." Science, yes, but not just *new* science.


Illustrations: A visualization of the Stringency Index from the Covid-19 Government Response Tracker project.

Wendy M. Grossman is the 2013 winner of the Enigma Award. Her Web site has an extensive archive of her books, articles, and music, and an archive of earlier columns in this series. Stories about the border wars between cyberspace and real life are posted occasionally during the week at the net.wars Pinboard - or follow on Twitter.

April 2, 2021

Medical apartheid

swiss-cheese-virus-defence.jpgEver since 1952, when Clarence Willcock took the British government to court to force the end of wartime identity cards, UK governments have repeatedly tried to bring them back, always claiming they would solve the most recent public crisis. The last effort ended in 2010 after a five-year battle. This backdrop is a key factor in the distrust that's greeting government proposals for "vaccination passports" (previously immunity passports). Yesterday, the Guardian reported that British prime minister Boris Johnson backs certificates that show whether you've been vaccinated, have had covid and recovered, or had a test. An interim report will be published on Monday; trials later this month will see attendees to football matches required to produce proof of negative lateral flow tests 24 hours before the game and on entry.

Simultaneously, England chief medical officer Chris Whitty told the Royal Society of Medicine that most experts think covid will become like the flu, a seasonal disease that must be perennially managed.

Whitty's statement is crucial because it means we cannot assume that the forthcoming proposal will be temporary. A deeply flawed measure in a crisis is dangerous; one that persists indefinitely is even more so. Particularly when, as this morning, culture secretary Oliver Dowden tries to apply spin: "This is not about a vaccine passport, this is about looking at ways of proving that you are covid secure." Rebranding as "covid certificates" changes nothing.

Privacy advocates and human rights NGOs saw this coming. In December, Privacy International warned that a data grab in the guise of immunity passports will undermine trust and confidence while they're most needed. "Until everyone has access to an effective vaccine, any system requiring a passport for entry or service will be unfair." We are a long, long way from that universal access and likely to remain so; today's vaccines will have to be updated, perhaps as soon as September. There is substantial, but not enough, parliamentary opposition.

A grassroots Labour discussion Wednesday night showed this will become yet another highly polarized debate. Opponents and proponents combine issues of freedom, safety, medical efficacy, and public health in unpredictable ways. Many wanted safety - "You have no civil liberties if you are dead," one person said; others foresaw segregation, discrimination, and exclusion; still others cited British norms in opposing making compulsory either vaccinations or carrying any sort of "papers" (including phone apps).

Aside from some specific use cases - international travel, a narrow range of jobs - vaccination passports in daily life are a bad idea medically, logistically, economically, ethically, and functionally. Proponents' concerns can be met in better - and fairer - ways.

The Independent SAGE advisory group, especially Susan Michie, has warned repeatedly that vaccination passports are not a good solution for solution life. The added pressure to accept vaccination will increase distrust, she has repeatedly said, particularly among victims of structural racism.

Instead of trying to identify which people are safe, she argues that the government should be guiding employers, businesses, schools, shops, and entertainment venues to make their premises safer - see for example the CDC's advice on ventilation and list of tools. Doing so would not only help prevent the spread of covid and keep *everyone* safe but also help prevent the spread of flu and other pathogens. Vaccination passports won't do any of that. "It again puts the burden on individuals instead of spaces," she said last night in the Labour discussion. More important, high-risk individuals and those who can't be vaccinated will be better protected by safer spaces than by documentation.

In the same discussion, Big Brother Watch's Silkie Carlo predicted that it won't make sense to have vaccination passports and then use them in only a few places. "It will be a huge infrastructure with checkpoints everywhere," she predicted, calling it "one of the civil liberties threats of all time" and "medical apartheid" and imagining two segregated lines of entry to every venue. While her vision is dramatic, parts of it don't go far enough: imagine when this all merges with systems already in place to bar access to "bad people". Carlo may sound unduly paranoid, but it's also true that for decades successive British governments at every decision point have chosen the surveillance path.

We have good reason to be suspicious of this government's motives. Throughout the last year, Johnson has been looking for a magic bullet that will fix everything. First it was contact tracing apps (failed through irrelevance), then test and trace (failing in the absence of "and isolate and support"), now vaccinations. Other than vaccinations, which have gone well because the rollout was given to the NHS, these failed high-tech approaches have handed vast sums of public money to private contractors. If by "vaccination certificates" the government means the cards the NHS gives fully-vaccinated individuals listing the shots they've had, the dates, and the manufacturer and lot number, well fine. Those are useful for those rare situations where proof is really needed and for our own information in case of future issues, it's simple, and not particularly expensive. If the government means a biometric database system that, as Michie says, individualizes the risk while relieving venues of responsibility, just no.

Illustrations: The Swiss Cheese Respiratory Virus Defence, created by virologist Ian McKay.

Wendy M. Grossman is the 2013 winner of the Enigma Award. Her Web site has an extensive archive of her books, articles, and music, and an archive of earlier columns in this series. Stories about the border wars between cyberspace and real life are posted occasionally during the week at the net.wars Pinboard - or follow on Twitter.